Doctors urged to ease cancer pain

March 03, 1994|By Jonathan Bor | Jonathan Bor,Sun Staff Writer

WASHINGTON -- Millions of Americans suffer needlessly from cancer pain each year because of widely held myths that painkilling drugs turn patients into addicts and lose their potency when they are needed most, a federal panel said yesterday.

The 26-member task force also attributed the problem to doctors who fail to ask their patients about pain, patients who fear being seen as wimps, medical schools that ignore the topic -- and the shared belief that pain is inevitable.

"Given what we know about pain management, there is no reason for patients to experience unrelieved, severe pain and every reason why clinicians and families should take an aggressive approach to its control," said Ada Jacox, professor at the Johns Hopkins School of Nursing and a co-chair of the panel.

Dr. Jacox said that relentless pain can weaken a patient's ability to fight cancer by limiting physical activity, reducing appetite, interfering with sleep and increasing the fear of cancer.

After reviewing thousands of studies, documents and other sources, the panel issued a 257-page manual aimed at helping doctors to appreciate their patients' suffering and to relieve their pain with drugs, surgery, psychotherapy and other techniques.

It also released a consumer guide to pain management.

Free copies of both publications can be obtained by calling toll-free, 1-800-422-6237.

The panel -- composed of doctors, nurses and patients -- was assembled in 1991 by the federal Agency for Health Care Policy and Research, which issued a similar manifesto on post-operative pain two years ago.

In that report, a panel urged doctors to use painkilling drugs more aggressively in the days following surgery -- and often to let patients dose themselves with bedside pumps.

About 8 million Americans are living with cancer or have a history of the disease.

Seventy percent suffer substantial pain at some stage of their disease, said Dr. Stuart Grossman, a Johns Hopkins oncologist who advised the cancer panel.

Pain can develop when cancer invades bone or tumors press against organs.

Chemotherapy, radiation and other treatments can also cause pain.

About 85 percent of the time, suffering can be relieved with morphine and other opiates, which can be administered through pills, skin patches, injections or intravenous infusions.

Most of the remaining cases can be managed with anti-inflammatory drugs, nerve blocks, radiation, surgery or anti-depressant medications.

Among the panel's recommendations:

* Mild pain can usually be relieved with a class of drugs known as nonsteroidal anti-inflammatories, which include aspirin and ibuprofen.

* Opiates should be used when pain persists or increases. Doctors should start with low doses, then increase the dosage as pain becomes more severe.

Medication should be given around the clock to maintain constant level in the bloodstream.

* Doctors should regularly ask patients to assess their pain -- to rate their pain on a 1-to-10 scale and describe exactly where they hurt.

"Traditionally, clinicians have discouraged patients from talking about pain," said Dr. Richard Payne, an oncologist with M. D. Anderson Cancer Center in Houston and the panel's co-chairman.

"Many cancer patients are reluctant to talk about pain with their doctors and nurses for fear of being labeled a complaining patient and because they may not want to distract the doctor from the equally important task of treating the cancer."

Patients taking opiates on a long-term basis usually develop a tolerance for the drug -- needing higher doses to maintain the effect, panelists said. And the patients will become sick with withdrawal symptoms if the drugs are suddenly stopped.

But panel members tried hard to debunk the "myth" that these are reasons to withhold drugs from patients.

There is nothing wrong with increasing medications in the interest of comfort, they said, and patients who no longer need them can be safely weaned if the drugs are tapered.

Patients who develop tolerances sometimes reach a point where no dose is effective, Dr. Jacox said. But usually, she said, these patients can be successfully switched to other drugs.

Dr. Grossman, who heads the cancer pain program at the Johns Hopkins Oncology Center, said patients don't develop the psychological craving for painkilling drugs that characterizes a true "addict."

"Psychological addiction is where you turn your life upside down in the quest for the drug's psychological benefits. Your family relationships fall apart; you steal. That doesn't happen to our cancer patients."

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